Internet information and medical consultations: experiences from patients' and physicians' perspectives

OBJECTIVE: Many patients use the Internet to obtain health-related information. It is assumed that health-related Internet information (HRII) will change the consultation practice of physicians. This article explores the strategies, benefits and difficulties from the patients' and physicians' perspective. METHODS: Semi-structured interviews were conducted independently with 32 patients and 20 physicians. Data collection, processing and analysis followed the core principles of Grounded Theory. RESULTS: Patients experienced difficulties in the interpretation of the personal relevance and the meaning of HRII. Therefore they relied on their physicians' interpretation and contextualisation of this information. Discussing patients' concerns and answering patients' questions were important elements of successful consultations with Internet-informed patients to achieve clarity, orientation and certainty. Discussing HRII with patients was appreciated by most of the physicians but misleading interpretations by patients and contrary views compared to physicians caused conflicts during consultations. CONCLUSION: HRII is a valuable source of knowledge for an increasing number of patients. Patients use the consultation to increase their understanding of health and illness. Determinants such as a patient-centred consultation and timely resources are decisive for a successful, empowering consultation with Internet-informed patients. PRACTICAL IMPLICATIONS: If HRII is routinely integrated in the anamnestic interview as a new source of knowledge, the Internet can be used as a link between physicians' expertise and patient knowledge. The critical appraisal of HRII during the consultation is becoming a new field of work for physicians.

Feasibility and safety of same-day home discharge after radiofrequency catheter ablation

Interventional cardiology in a day-case setting might reduce logistic constraints on hospital resources. However, in contrast with coronary angioplasty, few data support the feasibility and safety of radiofrequency catheter ablation (RCA). The aim of this prospective, multicenter cohort study was to evaluate the feasibility and safety of RCA in 1,342 patients (814 men; mean age 57 +/- 17 years) considered eligible for ambulatory RCA, according to specific set of criteria, for common atrial flutter (n = 632), atrioventricular nodal reentrant tachycardia (n = 436), accessory pathways (n = 202), and atrial tachycardia (n = 72). Patients suitable for early discharge (4 to 6 hours after uncomplicated RCA) were scheduled for 1-month follow-up. Predictive factors for delayed complications were studied by multivariate analysis. Of the 1,342 enrolled patients, 1,270 (94.6%) were discharged the same day and followed for 1 month; no deaths occurred, and the readmission rate was 0.79% (95% confidence interval 0.30% to 1.27%). Six patients had significant puncture complications, 2 presented with symptomatic delayed pulmonary embolism, and 2 had new onset of poorly tolerated atrial flutter. None of these complications was life threatening. Multivariate analysis did not identify any significant independent predictors for delayed complications. In conclusion, these data suggest that same-day discharge after uncomplicated RCA for routine supraventricular arrhythmias is safe and may be applicable in clinical practice. This approach is known to be associated with significant patient satisfaction and cost savings and can be considered a first-line option in most patients who undergo routine ablation procedures.

Social Support Quality in Internet Based Information and Communication: From "Digital Divide" to "Voice Divide"

National and international studies demonstrate that the number of teenagers using the inter-net increases. But even though they actually do have access from different places to the in-formation and communication pool of the internet, there is evidence that the ways in which teenagers use the net - regarding the scope and frequency in which services are used as well as the preferences for different contents of these services - differ significantly in relation to socio-economic status, education, and gender. The results of the regarding empirical studies may be summarised as such: teenager with low (formal ) education especially use internet services embracing 'entertainment, play and fun' while higher educated teenagers (also) prefer intellectually more demanding and particularly services supplying a greater variety of communicative and informative activities. More generally, pedagogical and sociological studies investigating "digital divide" in a dif-ferentiated and sophisticated way - i.e. not only in terms of differences between those who do have access to the Internet and those who do not - suggest that the internet is no space beyond 'social reality' (e.g. DiMaggio & Hargittai 2001, 2003; Vogelgesang, 2002; Welling, 2003). Different modes of utilisation, that structure the internet as a social space are primarily a specific contextualisation of the latter - and thus, the opportunities and constraints in virtual world of the internet are not less than those in the 'real world' related to unequal distribu-tions of material, social and cultural resources as well as social embeddings of the actors involved. This fact of inequality is also true regarding the outcomes of using the internet. Empirical and theoretical results concerning forms and processes of networking and commu-nity building - i.e. sociability in the internet, as well as the social embeddings of the users which are mediated through the internet - suggest that net based communication and infor-mation processes may entail the resource 'social support'. Thus, with reference to social work and the task of compensating the reproduction of social disadvantages - whether they are medial or not - the ways in which teenagers get access to and utilize net based social sup-port are to be analysed.

RFID Transponders : Link between information and material flows. How reliable are identification procedures?

Along with the growing complexity of logistic chains the demand for transparency of informations has increased. The use of intelligent RFID-Technology offers the possibility to optimize and control all capacities in use, since it enables the identification and tracking of goods alongside the entire supply chain. Every single product can be located at any given time and a multitude of current and historical data can be transferred. The interaction of the flow of material and the flow of information between the various process steps can be optimized by using RFID-Technology since it guarantees that all required data is available at the right time and at the right place. The local accessibility and convertibility of data allows a flexible, decentralised control of logistic systems. As additional advantages of RFID-Components can be considered that they are individually writable and that their identification can be achieved over considerable distances even if there is no intervisibility between tag and reader. The use of RFID-Transponder opens up new potentials regarding process security, reduction of logistic costs or availability of products. These advantages depend on reliability of the identification processes. The undisputed potentials that are made accessible by the use of RFID-Elements can only be beneficial when the informations that are decentralised and attached to goods and loading equipment can be reliably retrieved at the required points. The communication between tag and reader can be influenced by different materials such as metal, that can disturbed or complicate the radio contact. The communications reliability is subject of various tests and experiments that analyse the effects of different filling materials as well as different alignments of tags on the loading equipment.

Influence of Information and Instructions on Human Behavior in Tunnel Accidents: A Virtual Reality Study

Human behavior is a major factor modulating the consequences of road tunnel accidents. We investigated the effect of information and instruction on drivers' behavior as well as the usability of virtual environments to simulate such emergency situations. Tunnel safety knowledge of the general population was assessed using an online questionnaire, and tunnel safety behavior was investigated in a virtual reality experiment. Forty-four participants completed three drives through a virtual road tunnel and were confronted with a traffic jam, no event, and an accident blocking the road. Participants were randomly assigned to a control group (no intervention), an informed group who read a brochure containing safety information prior to the tunnel drives, or an informed and instructed group who read the same brochure and received additional instructions during the emergency situation. Informed participants showed better and quicker safety behavior than the control group. Self-reports of anxiety were assessed three times during each drive. Anxiety was elevated during and after the emergency situation. The findings demonstrate problematic safety behavior in the control group and that knowledge of safety information fosters adequate behavior in tunnel emergencies. Enhanced anxiety ratings during the emergency situation indicate external validity of the virtual environment.

Breast cancer on the world wide web: cross sectional survey of quality of information and popularity of websites.

OBJECTIVES: To determine the characteristics of popular breast cancer related websites and whether more popular sites are of higher quality. DESIGN: The search engine Google was used to generate a list of websites about breast cancer. Google ranks search results by measures of link popularity---the number of links to a site from other sites. The top 200 sites returned in response to the query "breast cancer" were divided into "more popular" and "less popular" subgroups by three different measures of link popularity: Google rank and number of links reported independently by Google and by AltaVista (another search engine). MAIN OUTCOME MEASURES: Type and quality of content. RESULTS: More popular sites according to Google rank were more likely than less popular ones to contain information on ongoing clinical trials (27% v 12%, P=0.01 ), results of trials (12% v 3%, P=0.02), and opportunities for psychosocial adjustment (48% v 23%, P<0.01). These characteristics were also associated with higher number of links as reported by Google and AltaVista. More popular sites by number of linking sites were also more likely to provide updates on other breast cancer research, information on legislation and advocacy, and a message board service. Measures of quality such as display of authorship, attribution or references, currency of information, and disclosure did not differ between groups. CONCLUSIONS: Popularity of websites is associated with type rather than quality of content. Sites that include content correlated with popularity may best meet the public's desire for information about breast cancer.